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General NPI Number Information
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NPI Number | 1477761203
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Entity Type | Individual
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Provider Name | SIDDHARTH PRAKASH M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 2025 RICHMOND AVE STE 1A
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3915
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Country | US
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Telephone | 718-494-0800
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Fax |
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Provider Business Mailing Address
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Address Line | 222 E 68TH ST
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City | NEW YORK
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State | NY
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Zip | 10065-6001
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Country | US
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Telephone | 212-879-4488
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 243250
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License Number State | NY
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